心脏术后高胆红素血症的血浆置换治疗

Plasma Exchange Treatment of Hyperbilirubinemia after Cardiac Surgery

目的总结我中心对心脏术后出现高胆红素血症患者使用血浆置换治疗的经验。方法 2012年2月-2014年7月2800例心脏术后的患者中,有6例(0.2%)出现肝功能衰竭,并出现持续严重高胆红素血症,对这6例患者进行血浆置换治疗。患者均合并多脏器功能衰竭,包括心功能不全、肾功能衰竭及呼吸衰竭。结果 6例患者共进行10次血浆置换治疗。每次血浆置换治疗后,血清总胆红素(TB)、结合胆红素(CB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、国际标准化比值(INR)有一定的下降,其中TB和CB下降可显著下降(具体结果加P值);血细胞、白蛋白、肾功能、电解质变化不明显。在治疗1-2次后3例患者治疗有效,TB在数天内降至100 umol/L左右(P<0.01),余3例患者胆红素升至治疗前水平。6例患者中4例死亡(2例成功更重要,应该写:经过血浆置换治疗,2/6例最终抢救成功,….出院?)。结论心脏术后出现严重高胆红素血症常的患者预后差,血浆置换治疗能够在一定程度上降低血清胆红素,对预后的影响仍需进一步研究。

Objectives To analyze the efficacy and safety of plasma exchange given to patients with hyperbilirubinemia after cardiac surgery in our center. Methods From 2012.4 to 2014.7,a total of 6 of 2800 patients（0.2%） after cardiac surgery who were diagnosed as liver failure and severe hyperbilirubinemia were treated with plasma exchange.All 6 patients were complicated with multiple organ failure, including heart failure, renal failure, respiratory failure. Results All 6 patients were treated with plasma exchange totally 10 times; After the treatment, serum total bilirubin （TB）,conjugated bilirubin（CB）,alanine aminotransferase（ALT）,aspartate amino transferase（AST） ,international normalized ratio（INR）deereased, with statistical difference in TB and CB（P 〈 0.01）. The decreased levels in blood cells, albumin, renal function and electrolyte were not statistically significant. Three of these patients were treated effectively after 1-2 times of plasma exchange with decreased TB of 100 umol/L in a few days. Two of these 3 patents survived to hospital discharge with normal liver function and renal function, while the other 3 patients died with increased TB level as same as that before treatment. Conclusion Prognosis of patients with severe hyperbilirubinemia after cardiac surgery is poor. Plasma exchange therapy may reduce the serum bilirubin level in a certain extent. But the effect of plasma exchange on prognosis remains to be further studied.